16 May 2012

At-home HIV test gets thumbs up

A US Food and Drug Administration advisory panel recommended approval of the first HIV test that would give people the results in the privacy of their own home.

A US Food and Drug Administration advisory panel recommended approval of the first HIV test that would give people the results in the privacy of their own home.

The 17 panel members were unanimous in voting that the benefits of the test were greater than any possible risks. The test kit, known as Oraquick, detects the presence of HIV - the virus that causes Aids - within 20 minutes, the Associated Press reported.

If the FDA heeds the recommendation of its advisory panel, the decision could pave the way toward a new era in HIV testing. The agency typically follows the recommendations of its advisory groups.

OraSure Technologies Inc., which makes the over-the-counter test, already sells a version of it to doctors and other health professionals. Studies have shown the test was less accurate when used by consumers, but the panellists said that the benefits of expanding HIV testing outweigh a small drop in test accuracy, according to the AP.

"There is huge global momentum in support of over-the-counter testing for HIV. People desire private, discreet options that protect their confidentiality," said Dr Nitika Pant Pai, an assistant professor of medicine at Montreal's McGill University who co-authored an analysis of the effectiveness of an at-home HIV test earlier this year.

How the test works

The test, which looks for signs of HIV in oral fluid, is already used at hospitals and doctors' offices where medical professionals administer it. The FDA first approved its use in 2004.

To take the OraQuick test, people swab their outer gums and put the swab into a vial. After about 20 minutes, the test device will reveal two reddish-purple lines in a small window if there are signs that the body's immune system has geared up to battle HIV.

The test uses oral fluid, which is not the same as saliva. Its results are considered preliminary, and should be confirmed by a blood test.

OraSure had nearly 5 700 people take the at-home version of the test. The tests found that 114 thought they were HIV-positive; 106 of them actually were. That means that positive results were accurate 93% of the time. Negative results were accurate 99.98% of the time, the company said.

Pant Pai said the oral test's overall accuracy is similar to that of a blood test, although it's slightly less accurate. The oral test, in particular, may miss HIV infection in its early stages, she said.

Concern for lack of counselling at home

Also, "the sensitivity of the test appears lower when administered in the home setting rather than a medical setting, so some of the people who are HIV-positive will get a test result that they are negative," said Jane Rotheram-Borus, director of the Center for HIV Identification Prevention & Treatment Services at the University of California, Los Angeles. "However, if they would otherwise not have gotten the test at all, they may also have believed they were negative."

Experts have expressed concern for people who learn at home, possibly alone, that they are probably infected with the virus that causes Aids.

"The arguments against the at-home test focus on the absence of a counsellor who could provide support and link the newly identified HIV-positive individual to medical care," said Rotheram-Borus, who supports over-the-counter sales of the OraQuick test.

She pointed out that "over-the-counter pregnancy tests are widely used, and pregnant women do find their way into prenatal care."

Orasure has said it will offer a 24-hour toll-free number that people can call to get support regarding their test results. The comnpany has not determined the over-the-counter price of the test yet.

Ask the Expert

Dr Sindisiwe van Zyl qualified at the University of Pretoria before working for an HIV/AIDS NPO in Soweto for many years. She was named one of the Mail & Guardian's Top 200 Young South Africans in 2012.

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